(Part 2): Petilla Health Model

COMPLEMENTARY to the national government’s initiative to expand insurance coverage, the province also adopted a mechanism to further increase Philhealth enrolment in its locality. To target individually paying members (whose challenge is to induce voluntarily enrolment, and regular and on-time payment of premiums), the province regularly promoted the services and benefits of Philhealth and disseminated reminders about relevant payment information via SMS.
Expansion of enrolment among the poor is also given importance. While the adoption of the National Household Targeting System (NHTS) database aided the national government in identifying poor families to be enrolled under the Sponsored Program, it does not guarantee inclusion of every poor household. And even if a poor Filipino is enrolled as sponsored, the use of the Philhealth benefit (or of the facility, to begin with) is not guaranteed either.

The development of a system called the Philhealth Link program aided the province in addressing this problem. Designed to enable membership verification within the facility (in the case for example, when sponsored patients are unaware of their Philhealth enrolment), the program also becomes a useful tool for enrollment expansion.

Under the program, a facility personnel coordinates with a Philhealth employee who then validates the membership by matching the name, age, and/or residence of the patient, thus allowing for verification even in the absence of Philhealth ID. (To incentivize proper and efficient matching, the province compensates the Philhealth personnel-in-charge based on the number of cases successfully matched).

This mechanism allowed the facility to identify and include dependents, as well as poor patients not sponsored by the government since they are yet to be included in the NHTS (National Household Targeting System) database. Identified dependents and poor patients (as verified by a Department of Social Welfare and Development [DSWD} officer installed within the facility) are subsequently included in the list of sponsored members, thus ensuring the grant of Philhealth benefits to poor patients who choose to use the services in the facility.

Using radio broadcasts, billboard installation, and SMS, the province also promoted its health facilities — particularly the free services available to the poor — to further induce better availment. Using the funds received by the facilities from Philhealth, the province even provided monetary “rewards” for every service used by the patient; not only as a form of incentive but also to address the constraints entailed from lack of transportation money.

LESSONS FROM THE MODEL
Critical to the success of the Petilla Health Model is the incorporation of an effective incentive mechanism to drive each player to behave in a manner that resulted in mutually beneficial outcomes for the various stakeholders: higher funds from Philhealth prompted local officials to ascertain the insurance coverage and service availment by the public; higher returns of rendering service in public facilities encouraged retention of doctors in government hospitals; and the ensured access and affordability of services, in addition to the rewards offered, encouraged the public to make use of the health services available.

Yet, despite its commendable outcomes, the Petilla model is not perfect. There are still ample opportunities for its improvement; it is not politically easy to implement, and has yet to cover services at the municipal level. It also may or may not be fully replicable in other areas. But surely, the basic lessons behind the reforms — coordination, information, simplicity of rules, innovative use of resources, and incentives — can be an effective guide for other local governments to follow.

(The author is a researcher of and a member of the Sin Tax team of Action for Economic Reforms.)

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